1164510913 NPI number — DR. KIRSTEN HAMILTON DEGONZAGUE DC

Table of content: DR. KIRSTEN HAMILTON DEGONZAGUE DC (NPI 1164510913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164510913 NPI number — DR. KIRSTEN HAMILTON DEGONZAGUE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGONZAGUE
Provider First Name:
KIRSTEN
Provider Middle Name:
HAMILTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILTON
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1164510913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 SWARTSON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12209-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-489-0963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 FULLER RD
Provider Second Line Business Practice Location Address:
INNER BALANCE CHIROPRACTIC
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-482-2003
Provider Business Practice Location Address Fax Number:
518-482-2087
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X009755-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10095460 . This is a "CDPHP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO9755-2 . This is a "WORKER COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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